Active NPI
Avera McKennan
Doing business as Avera Medical Group Health Care Clinic Sioux Falls
- Internal Medicine Physician
- Sioux Falls, SD
National Provider Identifier
1083894067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- AVERA MCKENNAN
- Doing business as
- Avera Medical Group Health Care Clinic Sioux Falls
- Practice address
- 300 N Dakota Ave.
Ste. 117
Sioux Falls, SD 57104-6020 - Phone
- (605) 322-6800
- Fax
- (605) 322-6802
- NPI assigned
- Nov 7, 2007
- Last updated
- Oct 24, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- David Flicek
- Title
- Ceo/President
- Phone
- (605) 322-8000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | NU | Primary |
Addresses
Primary practice location
300 N Dakota Ave.
Ste. 117
Sioux Falls, SD 57104-6020
Mailing address
PO Box 86370
Sioux Falls, SD 57118-6370
Phone (605) 322-7510
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0532341 | Medicaid | IA | |
| 12262 | Medicaid | ND | |
| 9251873 | Other | SD | DAKOTACARE |
| 0006020 | Other | SD | BLUE CROSS OF SOUTH DAKOT |
| 57105F001 | Other | SD | TRICARE |
| 30B74GU | Other | MN | BLUE CROSS |
| 59767 | Other | SD | HEALTHPARTNERS |
| 30B74GU | Other | SD | BLUE PLUS |
| 068417100 | Medicaid | MN |
Other names 1
- Avera Medical Group Health Care Clinic Sioux Falls
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031110000117 | SD | Part B Supplier - Clinic/Group Practice | 0345157103 |
Receives reassigned benefits from 1,418 practitioners This NPI is an additional NPI on the enrollment |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 43D0719165 | Avera Medical Group Health Care Clinic | Certificate of waiver | Mar 31, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Presentation Health Sys
Organizations with this tax ID in the same state 19
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
dba Avera Medical Group Addiction Medicine
- Addiction Medicine (Psychiatry & Neurology) Physician
- Sioux Falls, SD
- NPI 1013668698
-
dba Avera Dialysis Mitchell
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Mitchell, SD
- NPI 1023413093
-
dba Avera Medical Group McGreevy 69th & Minnesota Pediatrics
- Pediatrics Physician
- Sioux Falls, SD
- NPI 1033405436
-
dba Avera Prince of Peace Assisted Living
- Assisted Living Facility
- Sioux Falls, SD
- NPI 1053556068
-
dba Avera Interventional Radiology
- Diagnostic Radiology Physician
- Sioux Falls, SD
- NPI 1053680678
-
dba Avera Medical Group Brookings
- Clinical Medical Laboratory
- Brookings, SD
- NPI 1063782373
-
dba Avera Children's
- Pediatric Hematology & Oncology Physician
- Sioux Falls, SD
- NPI 1144488537
-
dba Avera Medical Group 69th and Cliff
- Family Medicine Physician
- Sioux Falls, SD
- NPI 1144635863
-
dba Avera McKennan Hospital and University Health Center - Diabetic Ed
- General Acute Care Hospital
- Sioux Falls, SD
- NPI 1154531630
-
dba Avera Addiction Care Center
- Substance Abuse Rehabilitation Facility
- Sioux Falls, SD
- NPI 1154979805
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Internal Medicine Physician
- Sioux Falls, SD
- NPI 1891221123
-
- Nurse Practitioner
- Sioux Falls, SD
- NPI 1336759612
-
- Internal Medicine Physician
- Sioux Falls, SD
- NPI 1336434737
-
- Family Nurse Practitioner
- Sioux Falls, SD
- NPI 1013662527
-
- Internal Medicine Physician
- Sioux Falls, SD
- NPI 1124287859
-
- Internal Medicine Physician
- San Diego, CA
- NPI 1205270956
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194393600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1540339200000",
"number": "1083894067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 86370",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571186370",
"telephone_number": "605-322-7510",
"fax_number": "605-322-6475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 N DAKOTA AVE.",
"address_2": "STE. 117",
"city": "SIOUX FALLS",
"state": "SD",
"postal_code": "571046020",
"telephone_number": "605-322-6800",
"fax_number": "605-322-6802"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AVERA MCKENNAN",
"organizational_subpart": "NO",
"enumeration_date": "2007-11-07",
"last_updated": "2018-10-24",
"status": "A",
"authorized_official_last_name": "FLICEK",
"authorized_official_first_name": "DAVID",
"authorized_official_title_or_position": "CEO/PRESIDENT",
"authorized_official_telephone_number": "605-322-8000"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0532341",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "12262",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAKOTACARE",
"identifier": "9251873",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF SOUTH DAKOT",
"identifier": "0006020",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "57105F001",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "30B74GU",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "59767",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE PLUS",
"identifier": "30B74GU",
"state": "SD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "068417100",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Avera Medical Group Health Care Clinic Sioux Falls",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Avera Medical Group Health Care Clinic Sioux Falls",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Sioux Falls, SD
- Avera McKennan (Avera Medical Group Oncology and Hematology Sioux Falls)
- Avera McKennan (Avera Medical Group McGreevy 69th & Minnesota Pediatrics)
- Avera McKennan (Avera Prince of Peace Assisted Living)
- Avera McKennan (Avera Interventional Radiology)
- Avera McKennan (Avera Neonatology Sioux Falls)
- Avera McKennan (Avera Medical Group Hospitalists Sioux Falls)
- Avera McKennan (Avera Medical Group Orthopedics and Sports Medicine)
- Avera McKennan (Avera Neurosurgery - Mark W. Fox, M.D., FACS)
- Avera McKennan (Avera Medical Group-Internal Medicine-Women's)
- Avera McKennan (Avera Nephrology)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.